HIV Risk with prostitute

Hi Doctor,
two weeks ago I visited a prostitute in the London red light district (Soho).
I'd had a few drinks before hand so wasn't thinking straight.. Anyway after handing over the money we started kissing etc, and masturbating eachother.
Then things started heating up and as I became aroused I lay ontop of her and for a brief moment did the most stupid thing I've ever done in my life... I began rubbing my uncovered penis against the outside of her vagina.. then I stupidly slid it inside for about 3 strokes. I then realised how much of a dumb thing this was for me to do and pulled out and asked for a condom. Since then I have been worrying about contracting hiv ever since. I have read on some websites that heterosexual transmission of hiv has been increasing over the last few years.. it used to be thought of a disease amongst the gay community but not so nowadays... I was inside her vagina unprotected for 5 seconds maximum, so does this decrease my risk on catching hiv?? I didn't notice any blood afterwards, but is it true that it would take only a microscopic amount of blood in her vagina to come into contact with my penis for me to catch hiv??
I read somewhere that one of the factors that determine wether or not hiv is transmitted is the strength of the immiune system.
As I had alcohol in my system, this must have meant that my immune system was weakened making it more easier for hiv to be transmiited.. am I right??
Also this moment of stupidity has got me thinking about my sexual history.
Over the last few years I have been visiting transexual escorts. I have performed uncovered oral sex on them and have also recieved uncovered oral sex from them... On some occassions I have allowd them to ejaculate in my mouth. I understand that semen has high concentrations of hiv in it... I take it this also increases my chances of having caught the virus??
I would be very grateful for your opinion of my risks as it is all I think about day and night.

Thanks you in advance for your response and I wish you a happy new year.

Jay

[H. Hunter Handsfield, M.D.]

If this is really is "the most stupid thing" you have ever done, you've led a pretty simple life.  And indeed, clearly it was not:  performing oral sex on pre-surgical transsexual men, especially with ejaculation in your mouth, is riskier.

Your new news is actually very old:  it has been known (and widely publicized) for a quarter century that sexual transmission of HIV is not limited to gay men.

But still HIV is pretty hard to transmit during a single episode of vaginal sex.  The escort event you describe is no reason for HIV testing.  However, your general lifestyle suggests you should have an HIV test from time to time, such as once a year.  So if you haven't been tested recently, and since it's on your mind, this would be a good time to do it.

Good luck--  HHH, MD

[jaysmith]

Thank you for the reply Doctor.. much appreciated.
You said that the episode with the escort does not require hiv testing...does this mean the risk of me catching hiv from that episode is so small it is not worth worrying about?

Also you mentioned that the oral sex with the transexuals was more risky as it involved ejaculation.... but exactly how risky is this? Some websites say there is no risk of hiv from oral sex even with ejaculation... others say there is a significant risk as semen and pre-*** have high levels of hiv?

Sorry to keep going on about it but I'm really worried... I know I should just go and get a test, but the incident was only 2 weeks ago, and I need to wait 3 months.
I was thinking about taking a test next week (i.e. 3 weeks after the incident), which will clear me for all my sexual history for the previous 3 months... then I was planning on having one test each week upto the 3 month limit after the incident.

[xworriedx]

You can have a test at six weeks that will be close to 99% acurate.

Also the Dr, has never seen anyone test negative at six weeks go on to test positive, so take your six week test and move on with your life.

God Bless

[H. Hunter Handsfield, M.D.]

From a risk perspective, I never recommend HIV testing after one-time sexual exposures, unless particularly high risk (e.g., unprotected male-male anal sex between unknown partners, or sex with a known HIV-infected person).  But as I said, from an anxiety-management standpoint, it's often the way to go.  A single test 6 weeks after the event is all that is needed.  It would be a ridculous waste of money, time and emotional energy for you to be tested with the frequency you suggest. For more information search the threads for "time to positive HIV test".

HHH, MD

[massguy]

Doctor, just read your response on here - isn't oral sex extremely low risk with a man?

[H. Hunter Handsfield, M.D.]

My risk assessments are not based only on the likelihood of transmission from a particular act, but also on the chance that a person's partner has HIV.  Relatively few female escorts have HIV; many gay/bi (and transsexual) men are infected.  In most settings in most industrialized countries, repeatedly performing fellatio on transsexual men definitely is higher risk for catching HIV than having occasional vaginal sex with an escort.

HHH, MD

[monkeyflower]

Dr. Handsfield: I'm guessing you mean transgender sex workers, not necessarily trans folks in general?

Original poster: I think the risk of contracting HIV from giving a blowjob to a *known* HIV positive person is 1 in 10,000. So even if your partner was HIV positive, the chances are really, really tiny. Still, you should get tested regularly; every sexually active person should.

[capone114]

Hello. I am a 22yr old male. I am extrmemely worried that I could have been infected with HIV.  I was at a porno shop one night in the month of November or December.  I went in one of the private back rooms to watch a porno and jack off. I used some lubricant.  As I was jacking off an older man walked in(in his 50's or 60's probbly) and grabbed by penis and jacked me off for a few seconds. ten seconds at most.  He looked dirty. Have no idea what was on his hands. What if he had *** or blood on his hands???? I also have HPV and I noticed I had a few tiny bumps on my penis. By the way I finished on my own jacking off afterwards and did ejaculate. I am very concerned because of my symtoms (symptoms).. I have had no appetite watsoever for a very long time now. Sweating a little under armpits. tired and diarreha here and there. I have been worrying myself so much lately. It is driving me crazy!!! Can you let me know what you think of this situation PLEASE????
                       THANK YOU SO MUCH.

[fizzo]

A related discussion, What is my risk of HIV infection? was started.